Armed with startling information about HIV and hepatitis C infection rates in prison, a leading Canadian AIDS organization is calling for a clean needle program to curb transmissions in Canada’s jails.
A report by Canadian HIV/AIDS Legal Network argues that access to sterile injecting equipment for Canada’s prisoners would reduce the risks associated with injection drug use, including the transmission of HIV and hepatitis C virus (HCV).
Clean Switch: The Case for Prison Needle and Syringe Programs in Canada was released June 4.
Currently, there are no prison-based needle and syringe programs (PNSPs) in any of the country’s 53 federal prisons. In Canadian prisons, the HIV transmission rate is seven to 10 times higher than in the general population. Rates of hepatitis transmission are 30 times higher among prisons than in the general population. According to recent research cited in the Clean Switch report, 29.9 per cent of Canadian inmates tested for hep C were positive.
Ralph Chernenko, a 47-year-old former inmate, was diagnosed with HIV 28 years ago. He’s unsure if he was infected while in prison. His drug use began when his father gave him Ritalin and Valium at the age of five. He continues to use morphine and cocaine intravenously.
“I had access to more drugs inside than what was on street. Before the province cut out smoking, it was fun to go to jail. Injecting drugs is a common thing inside,” says Chernenko.
Chernenko says getting drugs in prison was easier than getting drug paraphernalia, such as syringes. He says that, in prison, one new syringe costs approximately $100. That same syringe would then be used up to 200 times by about 100 people. When the syringe’s needle gets dull, it is sharpened. If it breaks, prisoners continue to use it, often leading to infected abscesses. He says PNSPs would definitely slow down HIV and HCV transmission in Canadian prisons.
Canada’s queer communities pioneered this kind of harm reduction approach to public health during the early days of the AIDS epidemic. They have long argued that health policies have to meet people where they’re at. Early harm reduction programs suggested, for example, that preaching condom use is more effective than abstinence in fighting sexually transmitted infections.
Sandra Chu is the lead author of Clean Switch and a senior policy analyst at the Canadian HIV/AIDS Legal Network. Chu says the Canadian government needs to work on pilot projects to implement PNSPs to reduce new infections in prison. But in order to make this program work, she says, people need to be reassured of their anonymity.
“There are different ways to implement (PNSPs). People who have been incarcerated told us is that’s its really important to have confidentiality. They don’t want to get caught getting a clean needle.”
Chu points out PNSPs are working successfully in other countries throughout Europe and Central Asia. In 1992, Switzerland became the first country to offer PNSPs. Since then, studies have shown a strong reduction in the prevalence of HIV and HCV infections in prisons that offer PNSPs.
“In countries where they offer PNSPs, they have machines where you put in your old needle and get a new needle. In theory, prison staff won’t know if you’re getting a clean needle,” says Chu.
Under the Correctional and Conditional Release Act — which governs the Correctional Service of Canada and all federal prisons — CSC is required “to take all reasonable steps to ensure that penitentiaries, the penitentiary environment, the living and working conditions of inmates and the working conditions of staff members are safe, healthful and free of practices that undermine a person’s sense of personal dignity.”
“People in the community have the tools to prevent themselves from contracting hep C and HIV. We shouldn’t deny those same tools to people inside prison. The majority of people in prison come out to the community — if they come out infected, that affects all of us,” says Chu.
Anne Marie Dicenco is the executive director of Prisoner’s HIV/AIDS Support Action Network.
She works with people in prison and people who have been released from prison who are HIV- and/or HCV-positive.
“There are needle exchange programs in the community, even though drugs are illegal. This isn’t a moral issue. This is a health issue. It’s a HCV/HIV issue. The reality is, people use drugs. That’s why a lot of people go to prison. If we know we’re locking up a lot of people who use drugs, then we need to think about the health consequences if they’re going to continue using drugs,” says Dicenco.
Heather, 33, prefers not to give her last name. She says she contracted HCV in prison, sharing needles for drug use. Before she went to prison, she shared needles and sold her body hundreds of times for money without any health problems. She is now five years sober, in remission from HCV, and lives with her wife and two children.
“Most prisoners have gone through life disobeying rules. Putting a Gideon Bible on their bed and telling them to pray and behave doesn’t work. They’re going to continue using drugs until they’re ready to stop.”
Heather says when she was in jail, she used drugs more often than when she was on the streets. She says injecting drugs inside was easier to get away with because there was no smell, as opposed to smoking marijuana or crack.
“And as long as you’re not making their job harder, the guards don’t care if you do drugs in jail.”
Caroline McNicoll, a communications advisor with CSC, declined to be interviewed.